Why wait? Answering the big questions of the vaccine reluctant

If only health experts had the right catch phrase to convince the Covid-19 vaccine reluctant to take a shot and help slow the Covid-19 pandemic.

Human decision-making is much more complicated than that.

Instead, those on the leading edges of health care have begun to focus on addressing the most common personal differences and objections when it comes to hesitancy as the worldwide vaccine supply grows, demand in the U.S. slides and the threat of virus variants lingers.

“It would be great if everyone struggled with the same kind of health information deficit and we could have a one-size-fits all approach, but this is a really complicated health problem,” said Dr. Jeffrey Lackner, professor and chief of the Division of Behavioral Medicine at the University at Buffalo Jacobs School of Medicine and Biomedical Sciences.

“There are no magic words to change behavior,” Lackner said. “You have to try to appeal to goals and aspirations, and create common ground.”

Data from eight countries including the U.S., pulled together late last year by survey company GWI, recommends looking at five archetypes to illustrate typical attitudes toward vaccines.

Vaccine supporters: They made up the largest group, at 66% of those surveyed.

The vaccine hesitant: They accounted for 12% and constitute those easily swayed by word-of-mouth and social media.

Vaccine obligators: The comprised 11% of the total, and likely only will get vaccinated if they must do so for travel, large gatherings, work or school. They doubt Covid-19 will harm them and tend to fear side effects more than the other groups.

The vaccine skeptical: Similar in size to the obligators, they share similar views but at this point have no intention to get vaccinated. They lack faith in science, institutions and the ability of a vaccine to end the global health crisis.

Anti-vaxxers: They made up the smallest slice, at about 1.4%. This subset of the vaccine skeptical believe safety risks far outweigh potential benefits of all vaccines.

“We have lumped the hesitant, obligated, skeptical, and anti-vaxxer into one group with the expectation that one message fits all,” said Dr. Willie Underwood III, executive director of the Buffalo Center for Health Equity“Unfortunately, this is not true. In my opinion, the goal should be to focus on the skeptical and hesitant because there is a chance of moving them to the supporter group.”

A dozen doctors and researchers contacted by WNY Refresh answered the most common questions they are fielding about the vaccine.

They do so at a time when almost every hospitalized patient in the region is unvaccinated and variants of concern that circulate here are nearly twice as contagious as the original version of the SARS-CoV-2 virus that swept through in large numbers last spring and winter.

“One of the saddest things in taking care of people – especially with how good the VA has been about calling patients and getting them in for vaccines – is when you see somebody in the intensive care unit on a ventilator who was called multiple times to come and get their vaccine and they refused every time. It’s tragic,” said Dr. Alan J. Lesse, associate professor and vice chair of the Department of Medicine at the Jacobs School who practices at the VA Western New York Health Care System.


The Objections

Q: The Covid-19 vaccines were made quickly and I’m uncomfortable with that. Why shouldn’t I wait to get one?

All those interviewed said this is the most common reason patients won’t get a vaccine.

The rapid development of Covid-19 vaccines traces to research started by coronavirus outbreaks caused by SARS-CoV-1, as well work during the 1980s to build a global research network to battle HIV. It continued this century during the severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS) outbreaks. And now, knowledge from mapping the Human Genome and dramatic advances in molecular sciences, laboratory research and drug development create greater possibilities, said global virology researcher Gene Morse, a SUNY Distinguished Professor at the UB School of Pharmacy and Pharmaceutical Sciences.

HIV is integrated into human DNA during its life cycle, which complicates the creation of a vaccine to prevent AIDS. The new coronavirus does not act that way, said Morse, which helps explain why Moderna and Pfizer-BioNTech were able to create mRNA vaccines that have proven so effective against Covid-19.

Financial and scientific investments by federal governments in the U.S. and other industrialized countries – as well the tens of thousands of willing volunteers who participated in Covid-19 vaccine clinical trials – provided a drug-development and testing force unparalleled in vaccine development.


Q: Nutritious eating, exercise, and other healthy choices, including vitamin supplements, do plenty to protect me from Covid-19. Why put something unnatural into my body when I built a strong immunity the right way – naturally? 

“If you’re in pristine shape, with a perfect immune system, a perfect nutritional status, a perfect weight, it’s not going to protect you from getting infected from SARS-CoV-2 and potentially developing Covid – the consequences of getting infected are uncertain both immediately, and over the ensuing weeks, months, and perhaps years,” said Dr. Thomas Russo, professor and chief of infectious diseases in the UB Jacobs medical school.

Infectious disease and other medical researchers around the world who set aside other projects to focus on the pandemic threat have yet to find that any supplement, including vitamin D, prevents coronavirus infection, Russo said. Covid-19 mRNA vaccines, he said, are made using highly purified biologic components already familiar to the human body. They are designed to activate our body’s defense system to both block the SARS-CoV-2 from entering our human cells and to kill infected cells, thereby preventing the development of COVID.

Q: I got the virus and barely got sick. I’m sure I can do it again. Why should I get vaccinated, especially with a vaccine that can cause blood clots, shingles, severe allergic reactions and other serious side effects?


Four regional doctors talk about Covid-19 vaccine demand, reservations

“My response is to educate them on what I know, and what we as a medical community know, and become a sounding board,” one of the doctors said.

Protection through vaccination is more reliable in preventing Covid, especially against some of the newer variants, than if you were naturally infected with the versions of the virus responsible for the overwhelming majority of infections that have so far occurred in the U.S., Russo said. “It is likely that these new variants will only increase in prevalence over time and pose a significant risk for reinfection in the unvaccinated as we are seeing in other countries such as Brazil,” he said.

Studies show that the fear of shingles and infertility are unfounded, despite their reverberations social media platforms, Russo and Lesse said. They encouraged a focus on the New England Journal of Medicine, federal Centers for Disease Control and Prevention, and state and county health departments for more accurate information.

Nearly 265 million vaccines have been given in the U.S. since last fall and no deaths or blood clots from the authorized mRNA vaccines have been reported, Russo said. Allergic reactions have developed in about one in 1 million cases, usually within 15 minutes of injection, and all have been treated without serious consequences.

By contrast, more than 33 million Americans have been infected with the new coronavirus nationwide since the pandemic began, including more than 580,000 who died. More than 125,800 Western New Yorkers contracted the virus and more than 2,400 died.

“The younger and healthier you are, the less likely you are to have an immediate bad outcome – but unfortunately that number is not zero,” Russo said. “The risk of a child dying from Covid is far greater than from many childhood diseases that we routinely immunize against.” The number of younger people being hospitalized in the region, while small, has grown by percentage of overall cases as those older and more susceptible have largely been vaccinated. As cases increase, so does the risk of a bad outcome.

“Covid is totally unpredictable,” he said, and the likelihood of getting severe disease in any age group is far higher than the mild, short-lived side effects that come with RNA vaccines.”

Long-term Covid-19 risks remain unknown. Up to 25% of those with minor infections across all age groups have complained of headaches; brain fog; fatigue; sleep disorders; anxiety; depression; shortness of breath; loss, decreased, or abnormal taste and smell; pain; and blood clots Russo said. “This virus is just not a respiratory virus, but it can affect any organ in the body because it either directly infects and damage certain organs or indirectly by causing inflammation of our blood vessels.”


Q: I’m young and this could lead to infertility. Besides, I’m unlikely to get sick at all if I get Covid, so why bother?

If you get the virus, you could infect loved ones, friends and strangers, including those being treated for cancer and autoimmune diseases who may get far less immunity from vaccines and have a higher risk for serious illness and death from Covid-19.

Or take a more self-interested approach, said Dr. Raul Vazquez, head of Urban Family Practice, with offices on the Buffalo East and West sides.

Vazquez tells young patients that vaccines can’t cause infertility because of how they were made, but Covid-19 can. A recent study concluded it may significantly increase the risk of erectile dysfunction in men as young as their 30s.

“Sometimes, it’s just the reorientation of the information that they’re getting, Vazquez said, “because this hasn’t been real if they haven’t lost a loved one.”

Q: The coronavirus is no more dangerous than flu. This has been blown out of proportion for political reasons and to enrich special interests, including Bill Gates and the pharmaceutical industry.

Tens of thousands of Americans usually die during flu season. The death toll in the U.S. for Covid-19 is roughly 10 times higher than during the worst flu season we’ve had in decades – even though most people in the country locked down, wore masks and practiced social distancing in public, measures rarely used outside health care settings during pre-pandemic times. Those measures also dramatically limited the pain of the most recent flu season, Russo said.

“Frankly speaking,” he added, “we’re indebted to the pharmaceutical companies for developing these safe and effective vaccines so quickly. That’s the ticket out of this pandemic. Could you imagine if we didn’t have a vaccine at all right now where we’d be? Look at what’s going on right now in India and other countries where citizens aren’t getting vaccinated.”

Science matters, Russo said. It is no accident that communities with high vaccination rates, including San Francisco, have seen positive virus tests, hospitalizations and deaths plunge.

Q: Why should I trust the medical community? It long ago abandoned my neighborhood, and my family, friends and I have felt judged during past brushes with those at hospitals and in private medical practice.

Fallout from the murder last summer of George Floyd, under the knee of a Minneapolis police officer, also caused many in the regional health community to concede institutional bias toward the poor and people of color, Lesse said. He acknowledges those concerns from patients and asks that they give providers another chance now. Like almost all other physicians, he also tells patients that he and his loved ones have been vaccinated, and encourages them to do the same.

About 90% of the roughly 10,000 patients at Urban Family Practice are Black or Hispanic, said Vazquez, a plain-spoken Bronx native who came to Buffalo for medical school three decades ago and stayed. He hears this questions from many of his patients. His standard reply?

“America has never created a vaccine that would hurt white America,” he said. “And they sit back and they go, ‘Yeah.’ ”

The key to honoring and addressing reluctance, he said, is to get his patients in front of a trusted primary care provider willing to listen to concerns, help sort them out, and have a vaccine at the ready. This often works.

“Think about how much our lives would be different right now,” Vazquez said, “if the vaccine hadn’t been developed?”

Vaccines can get society “back to a level of normalcy,” he said, “which is what we want. And I think some people don’t understand that.”


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